Provider Demographics
NPI:1427647064
Name:BRANDT, MELISSA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:BRANDT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 PLEASANT VALLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1220
Mailing Address - Country:US
Mailing Address - Phone:703-631-1611
Mailing Address - Fax:
Practice Address - Street 1:25 BLACKSTONE VALLEY PL
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-1184
Practice Address - Country:US
Practice Address - Phone:866-799-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH06164183500000X
WVRP0008330183500000X
VA0202209394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist